The Dental Plan for Australia.
Reduced Fee Schedules
Get some idea of the great savings that NobleDentist offers.
NobleDentist Reduced Dental Fee Schedules
- New South Wales Reduced Dental Fee Schedule (NSW)
- Victoria Reduced Dental Fee Schedule (VIC)
- Queensland Reduced Dental Fee Schedule (QLD)
- Western Australia Reduced Dental Fee Schedule (WA)
- South Australia Reduced Dental Fee Schedule (SA)
- Australian Capital Territory Reduced Dental Fee Schedule (ACT)
- Tasmania Reduced Dental Fee Schedule (TAS)
- Northern Territory Reduced Dental Fee Schedule (NT)
New South Wales Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in New South Wales. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in New South Wales. Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $96 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $71 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $71 | 15% Off Practice Fee |
| 014 | Consultation | $100 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $50 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $130 | $84 |
| 071 | Diagnostic Model - Per Model | $91 | $48 |
| 072 | Photographic Records - Intraoral | $71 | $30 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $95 | $50 |
| 114 | Calculus Removal | $149 | $83 |
| 118 | Bleaching, External - Per Tooth | $247 | $72 |
| 121/111 | Topical Remineralising & Plaque | $111 | $39 |
| 141 | Oral Hygiene Instruction | $69 | $32 |
| 151 | Provision of Mouthguard | $254 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $74 | $43 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $224 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $487 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $228 | $129 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $406 | $242 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $90 | $35 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $369 | $204 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $198 | $88 |
| 417 | Pulp Obturation - One Canal | $345 | $190 |
| 418 | Pulp Obturation - Each Additional Canal | $188 | $88 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $251 | $129 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $207 | $91 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $177 | $104 |
| 512 | Metallic - 2 Surfaces | $209 | $128 |
| 513 | Metallic - 3 Surfaces | $265 | $151 |
| 514 | Metallic - 4 Surfaces | $309 | $168 |
| 515 | Metallic - 5 Surfaces | $365 | $190 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $192 | $112 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $226 | $135 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $280 | $160 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $335 | $181 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $396 | $216 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $198 | $121 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $246 | $147 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $299 | $173 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $365 | $195 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $419 | $223 |
| 575 | Pin Retention - Per Pin | $49 | $26 |
| 577 | Cusp Capping - Per Cusp | $56 | $29 |
| 578 | Restoration Incisal Corner - Per Corner | $91 | $31 |
| 582 | Composite Veneer - Direct - Per Tooth | $508 | $248 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,492 | $808 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,812 | $1,165 |
| 618 | Full Crown - Metallic - Indirect | $1,746 | $1,122 |
| 627 | Preliminary Restoration for Crown - Direct | $335 | $172 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1,614 | $925 |
| 651 | Re-cementing Crown or Veneer | $213 | $95 |
| 661 | Implant Abutment - Per Abutment | $1,472 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,494 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,693 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,791 | $906 |
| 719 | Upper & Lower Denture | $3,187 | $1,656 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,315 | $761 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,964 | $1,128 |
| 733 | Tooth/Teeth (Partial Denture) | $63 | $33 |
| 741 | Adjustment of a Denture | $96 | $47 |
| 743 | Relining - Complete Denture - Processed | $512 | $302 |
| 763 | Repair Base - Complete Denture | $254 | $132 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $266 | $147 |
| 776 | Impression for Denture Repair | $96 | $43 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,218 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $4,466 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $137 | $65 |
| 925 | Individually Made Tray - Medicament(s) | $254 | $110 |
| 965 | Occlusal Splint | $771 | $465 |
Victoria Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicate the amount patients could be charged when visiting a dentist in Victoria. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in Victoria . Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $81 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $67 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $61 | 15% Off Practice Fee |
| 014 | Consultation | $76 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $51 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $127 | $82 |
| 071 | Diagnostic Model - Per Model | $91 | $47 |
| 072 | Photographic Records - Intraoral | $75 | $28 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $93 | $52 |
| 114 | Calculus Removal | $151 | $82 |
| 118 | Bleaching, External - Per Tooth | $246 | $66 |
| 121/111 | Topical Remineralising & Plaque | $102 | $42 |
| 141 | Oral Hygiene Instruction | $66 | $34 |
| 151 | Provision of Mouthguard | $254 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $73 | $42 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $223 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $502 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $228 | $126 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $407 | $224 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $86 | $35 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $355 | $194 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $198 | $91 |
| 417 | Pulp Obturation - One Canal | $337 | $190 |
| 418 | Pulp Obturation - Each Additional Canal | $191 | $91 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $244 | $132 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $203 | $100 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $175 | $104 |
| 512 | Metallic - 2 Surfaces | $208 | $113 |
| 513 | Metallic - 3 Surfaces | $262 | $142 |
| 514 | Metallic - 4 Surfaces | $310 | $160 |
| 515 | Metallic - 5 Surfaces | $362 | $185 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $192 | $108 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $223 | $129 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $279 | $151 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $335 | $173 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $401 | $203 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $198 | $116 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $244 | $142 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $299 | $164 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $358 | $190 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $406 | $220 |
| 575 | Pin Retention - Per Pin | $50 | $26 |
| 577 | Cusp Capping - Per Cusp | $59 | $30 |
| 578 | Restoration Incisal Corner - Per Corner | $91 | $34 |
| 582 | Composite Veneer - Direct - Per Tooth | $508 | $246 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,472 | $816 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,817 | $1,184 |
| 618 | Full Crown - Metallic - Indirect | $1,738 | $1,146 |
| 627 | Preliminary Restoration for Crown - Direct | $340 | $176 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1,599 | $881 |
| 651 | Re-cementing Crown or Veneer | $203 | $104 |
| 661 | Implant Abutment - Per Abutment | $1,472 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,436 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,644 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,601 | $837 |
| 719 | Upper & Lower Denture | $3,045 | $1,510 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,259 | $699 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,929 | $1,146 |
| 733 | Tooth/Teeth (Partial Denture) | $66 | $33 |
| 741 | Adjustment of a Denture | $96 | $51 |
| 743 | Relining - Complete Denture - Processed | $508 | $293 |
| 763 | Repair Base - Complete Denture | $254 | $121 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $259 | $137 |
| 776 | Impression for Denture Repair | $96 | $44 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,411 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $4,263 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $128 | $65 |
| 925 | Individually Made Tray - Medicament(s) | $264 | $110 |
| 965 | Occlusal Splint | $761 | $423 |
Queensland Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in Queensland. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in Queensland . Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $95 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $72 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $71 | 15% Off Practice Fee |
| 014 | Consultation | $96 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $50 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $122 | $79 |
| 071 | Diagnostic Model - Per Model | $91 | $43 |
| 072 | Photographic Records - Intraoral | $66 | $28 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $86 | $46 |
| 114 | Calculus Removal | $150 | $82 |
| 118 | Bleaching, External - Per Tooth | $205 | $61 |
| 121/111 | Topical Remineralising & Plaque | $110 | $35 |
| 141 | Oral Hygiene Instruction | $65 | $30 |
| 151 | Provision of Mouthguard | $261 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $75 | $40 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $223 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $446 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $223 | $119 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $406 | 15% Off Practice Fee |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $86 | $30 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $370 | $195 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $198 | $97 |
| 417 | Pulp Obturation - One Canal | $351 | $190 |
| 418 | Pulp Obturation - Each Additional Canal | $187 | $97 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $253 | $127 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $208 | $91 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $173 | $94 |
| 512 | Metallic - 2 Surfaces | $206 | $117 |
| 513 | Metallic - 3 Surfaces | $267 | $144 |
| 514 | Metallic - 4 Surfaces | $305 | $164 |
| 515 | Metallic - 5 Surfaces | $360 | $190 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $188 | $104 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $224 | $125 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $279 | $146 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $335 | $173 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $401 | $207 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $201 | $112 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $246 | $138 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $301 | $168 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $365 | $187 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $401 | $216 |
| 575 | Pin Retention - Per Pin | $49 | $26 |
| 577 | Cusp Capping - Per Cusp | $59 | $28 |
| 578 | Restoration Incisal Corner - Per Corner | $91 | $28 |
| 582 | Composite Veneer - Direct - Per Tooth | $508 | $245 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,437 | $789 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,807 | $1,199 |
| 618 | Full Crown - Metallic - Indirect | $1,766 | $1,099 |
| 627 | Preliminary Restoration for Crown - Direct | $335 | $145 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1,596 | $845 |
| 651 | Re-cementing Crown or Veneer | $219 | $96 |
| 661 | Implant Abutment - Per Abutment | $1,475 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,517 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,570 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,785 | $867 |
| 719 | Upper & Lower Denture | $3,173 | $1,618 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,307 | $737 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,299 | $1,104 |
| 733 | Tooth/Teeth (Partial Denture) | $70 | $31 |
| 741 | Adjustment of a Denture | $100 | $46 |
| 743 | Relining - Complete Denture - Processed | $511 | $299 |
| 763 | Repair Base - Complete Denture | $254 | $116 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $266 | $138 |
| 776 | Impression for Denture Repair | $96 | $42 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,392 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $4,060 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $137 | $65 |
| 925 | Individually Made Tray - Medicament(s) | $254 | $104 |
| 965 | Occlusal Splint | $771 | $427 |
Western Australia Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in Western Australia. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in Western Australia. Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $87 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $71 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $69 | 15% Off Practice Fee |
| 014 | Consultation | $86 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $50 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $128 | $79 |
| 071 | Diagnostic Model - Per Model | $91 | $47 |
| 072 | Photographic Records - Intraoral | $56 | $26 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $86 | $47 |
| 114 | Calculus Removal | $149 | $83 |
| 118 | Bleaching, External - Per Tooth | $223 | $58 |
| 121/111 | Topical Remineralising & Plaque | $110 | $43 |
| 141 | Oral Hygiene Instruction | $67 | $35 |
| 151 | Provision of Mouthguard | $254 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $73 | $44 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $225 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $426 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $232 | $122 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $407 | $221 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $87 | $35 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $353 | $191 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $193 | $88 |
| 417 | Pulp Obturation - One Canal | $348 | $190 |
| 418 | Pulp Obturation - Each Additional Canal | $183 | $86 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $223 | $121 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $203 | $90 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $168 | $100 |
| 512 | Metallic - 2 Surfaces | $201 | $121 |
| 513 | Metallic - 3 Surfaces | $213 | $138 |
| 514 | Metallic - 4 Surfaces | $301 | $155 |
| 515 | Metallic - 5 Surfaces | $355 | $174 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $190 | $108 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $221 | $125 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $279 | $147 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $325 | $169 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $351 | $198 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $201 | $115 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $238 | $147 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $277 | $173 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $346 | $190 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $391 | $212 |
| 575 | Pin Retention - Per Pin | $46 | $27 |
| 577 | Cusp Capping - Per Cusp | $60 | $32 |
| 578 | Restoration Incisal Corner - Per Corner | $91 | $35 |
| 582 | Composite Veneer - Direct - Per Tooth | $436 | $236 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,484 | $751 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,726 | $1,113 |
| 618 | Full Crown - Metallic - Indirect | $1,726 | $1,087 |
| 627 | Preliminary Restoration for Crown - Direct | $290 | $178 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1,478 | $895 |
| 651 | Re-cementing Crown or Veneer | $202 | $91 |
| 661 | Implant Abutment - Per Abutment | $1,472 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,132 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,741 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,706 | $934 |
| 719 | Upper & Lower Denture | $3,094 | $1,625 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,282 | $792 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,942 | $1,079 |
| 733 | Tooth/Teeth (Partial Denture) | $62 | $36 |
| 741 | Adjustment of a Denture | $98 | $49 |
| 743 | Relining - Complete Denture - Processed | $508 | $317 |
| 763 | Repair Base - Complete Denture | $262 | $113 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $263 | $139 |
| 776 | Impression for Denture Repair | $86 | $42 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,487 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $2,609 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $122 | $67 |
| 926 | Individually Made Tray - Medicament(s) | $264 | $117 |
| 965 | Occlusal Splint | $761 | $441 |
South Australia Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in South Australia. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in South Australia . Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $81 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $67 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $61 | 15% Off Practice Fee |
| 014 | Consultation | $76 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $51 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $123 | $78 |
| 071 | Diagnostic Model - Per Model | $92 | $46 |
| 072 | Photographic Records - Intraoral | $49 | $30 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $95 | $50 |
| 114 | Calculus Removal | $136 | $85 |
| 118 | Bleaching, External - Per Tooth | $223 | $56 |
| 121/111 | Topical Remineralising & Plaque | $107 | $47 |
| 141 | Oral Hygiene Instruction | $68 | $37 |
| 151 | Provision of Mouthguard | $254 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $70 | $38 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $223 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $467 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $211 | $119 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $398 | $209 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $66 | $30 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $351 | $180 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $179 | $84 |
| 417 | Pulp Obturation - One Canal | $351 | $194 |
| 418 | Pulp Obturation - Each Additional Canal | $179 | $84 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $246 | $117 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $203 | $88 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $157 | $94 |
| 512 | Metallic - 2 Surfaces | $183 | $113 |
| 513 | Metallic - 3 Surfaces | $233 | $134 |
| 514 | Metallic - 4 Surfaces | $279 | $154 |
| 515 | Metallic - 5 Surfaces | $310 | $176 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $167 | $105 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $188 | $122 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $254 | $145 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $305 | $167 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $365 | $190 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $198 | $109 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $240 | $134 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $284 | $163 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $355 | $185 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $396 | $207 |
| 575 | Pin Retention - Per Pin | $45 | $26 |
| 577 | Cusp Capping - Per Cusp | $56 | $28 |
| 578 | Restoration Incisal Corner - Per Corner | $77 | $30 |
| 582 | Composite Veneer - Direct - Per Tooth | $508 | $224 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,477 | $738 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,726 | $1,126 |
| 618 | Full Crown - Metallic - Indirect | $1,726 | $1,057 |
| 627 | Preliminary Restoration for Crown - Direct | $294 | $151 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1600 | $820 |
| 651 | Re-cementing Crown or Veneer | $187 | $90 |
| 661 | Implant Abutment - Per Abutment | $1,421 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,385 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,619 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,421 | $845 |
| 719 | Upper & Lower Denture | $2,598 | $1,423 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,264 | $781 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,915 | $1,066 |
| 733 | Tooth/Teeth (Partial Denture) | $65 | $35 |
| 741 | Adjustment of a Denture | $96 | $47 |
| 743 | Relining - Complete Denture - Processed | $508 | $320 |
| 763 | Repair Base - Complete Denture | $234 | $116 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $264 | $141 |
| 776 | Impression for Denture Repair | $93 | $45 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,018 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $3,248 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $131 | $58 |
| 925 | Individually Made Tray - Medicament(s) | $260 | $108 |
| 965 | Occlusal Splint | $761 | $398 |
Australian Capital Territory Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in the Australian Capital Territory. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in the Australian Capital Territory. Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $91 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $71 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $71 | 15% Off Practice Fee |
| 014 | Consultation | $96 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $49 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $127 | $86 |
| 071 | Diagnostic Model - Per Model | $81 | $50 |
| 072 | Photographic Records - Intraoral | $49 | $37 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $93 | $55 |
| 114 | Calculus Removal | $142 | $95 |
| 118 | Bleaching, External - Per Tooth | $210 | $78 |
| 121/111 | Topical Remineralising & Plaque | $108 | $40 |
| 141 | Oral Hygiene Instruction | $66 | $39 |
| 151 | Provision of Mouthguard | $254 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $71 | $47 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $224 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $389 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $228 | $150 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $391 | $259 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $77 | $38 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $370 | $223 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $183 | $101 |
| 417 | Pulp Obturation - One Canal | $345 | $206 |
| 418 | Pulp Obturation - Each Additional Canal | $162 | $95 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $215 | $141 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $203 | $104 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $157 | $115 |
| 512 | Metallic - 2 Surfaces | $211 | $145 |
| 513 | Metallic - 3 Surfaces | $264 | $168 |
| 514 | Metallic - 4 Surfaces | $311 | $190 |
| 515 | Metallic - 5 Surfaces | $341 | $216 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $188 | $123 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $214 | $152 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $271 | $176 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $299 | $194 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $356 | $225 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $188 | $124 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $244 | $163 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $300 | $181 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $364 | $213 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $403 | $242 |
| 575 | Pin Retention - Per Pin | $49 | $26 |
| 577 | Cusp Capping - Per Cusp | $56 | $31 |
| 578 | Restoration Incisal Corner - Per Corner | $71 | $31 |
| 582 | Composite Veneer - Direct - Per Tooth | $477 | $275 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,421 | $881 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,756 | $1,260 |
| 618 | Full Crown - Metallic - Indirect | $1,726 | $1,258 |
| 627 | Preliminary Restoration for Crown - Direct | $350 | $166 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1,497 | $996 |
| 651 | Re-cementing Crown or Veneer | $218 | $106 |
| 661 | Implant Abutment - Per Abutment | $1,362 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,132 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,520 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,644 | $1,035 |
| 719 | Upper & Lower Denture | $2,662 | $1,829 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,217 | $820 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,736 | $1,208 |
| 733 | Tooth/Teeth (Partial Denture) | $61 | $35 |
| 741 | Adjustment of a Denture | $81 | $51 |
| 743 | Relining - Complete Denture - Processed | $508 | $327 |
| 763 | Repair Base - Complete Denture | $254 | $141 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $254 | $164 |
| 776 | Impression for Denture Repair | $81 | $48 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,218 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $3,553 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $132 | $69 |
| 925 | Individually Made Tray - Medicament(s) | $203 | $110 |
| 965 | Occlusal Splint | $761 | $535 |
Tasmania Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in Tasmania. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in Tasmania . Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $83 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $71 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $71 | 15% Off Practice Fee |
| 014 | Consultation | $90 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $49 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $118 | $83 |
| 071 | Diagnostic Model - Per Model | $88 | $47 |
| 072 | Photographic Records - Intraoral | $53 | $23 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $91 | $47 |
| 114 | Calculus Removal | $142 | $79 |
| 118 | Bleaching, External - Per Tooth | $228 | $70 |
| 121/111 | Topical Remineralising & Plaque | $102 | $43 |
| 141 | Oral Hygiene Instruction | $66 | $26 |
| 151 | Provision of Mouthguard | $213 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $73 | $41 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $213 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $365 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $223 | $139 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $406 | $258 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $61 | $31 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $362 | $208 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $191 | $95 |
| 417 | Pulp Obturation - One Canal | $330 | $206 |
| 418 | Pulp Obturation - Each Additional Canal | $191 | $95 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $224 | $146 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $174 | $96 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $173 | $116 |
| 512 | Metallic - 2 Surfaces | $208 | $141 |
| 513 | Metallic - 3 Surfaces | $249 | $167 |
| 514 | Metallic - 4 Surfaces | $305 | $184 |
| 515 | Metallic - 5 Surfaces | $355 | $196 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $188 | $121 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $213 | $142 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $267 | $165 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $316 | $188 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $387 | $207 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $201 | $123 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $236 | $155 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $284 | $179 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $327 | $205 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $398 | $222 |
| 575 | Pin Retention - Per Pin | $43 | $26 |
| 577 | Cusp Capping - Per Cusp | $53 | $30 |
| 578 | Restoration Incisal Corner - Per Corner | $74 | $32 |
| 582 | Composite Veneer - Direct - Per Tooth | $508 | $264 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,517 | $881 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,786 | $1,249 |
| 618 | Full Crown - Metallic - Indirect | $1,769 | $1,157 |
| 627 | Preliminary Restoration for Crown - Direct | $320 | $164 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1610 | $992 |
| 651 | Re-cementing Crown or Veneer | $220 | $102 |
| 661 | Implant Abutment - Per Abutment | $1,472 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,269 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,679 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,726 | $1,079 |
| 719 | Upper & Lower Denture | $3,069 | $1,703 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,218 | $802 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,726 | $1,066 |
| 733 | Tooth/Teeth (Partial Denture) | $64 | $34 |
| 741 | Adjustment of a Denture | $85 | $62 |
| 743 | Relining - Complete Denture - Processed | $489 | $353 |
| 763 | Repair Base - Complete Denture | $241 | $134 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $264 | $167 |
| 776 | Impression for Denture Repair | $86 | $44 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $1,018 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | $3,248 | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $125 | $63 |
| 925 | Individually Made Tray - Medicament(s) | $254 | $113 |
| 965 | Occlusal Splint | $663 | $466 |
Northern Territory Reduced Dental Fee Schedule
The 'Non-Members' dental fees listed below indicates the amount patients could be charged when visiting a dentist in Tasmania. The data is based on the Australian Dental Association's annual dental fee survey (plus inflation as the surveys were conducted approximately 12 months ago). The 'Members' dental fees is the amount members of NobleDentist pay when visiting a participating dentist in Northern Territory . Any dental services not included in this fee schedule are reduced by 15% off the usual practice fee that you attend.
This fee schedule is current as at 25.01.10 - the fee schedule is updated once a year.
| Item Number | Service | Non-Members | Members |
| Diagnostic | |||
|---|---|---|---|
| 011 | Oral Exam - Comprehensive | $73 | 15% Off Practice Fee |
| 012 | Oral Exam - Periodic | $73 | 15% Off Practice Fee |
| 013 | Oral Exam - Limited | $70 | 15% Off Practice Fee |
| 014 | Consultation | $73 | 15% Off Practice Fee |
| 022 | X-Ray - Per Film | $50 | 15% Off Practice Fee |
| 037 | X-Ray - Panoramic (OPG) | $113 | $95 |
| 071 | Diagnostic Model - Per Model | $83 | $47 |
| 072 | Photographic Records - Intraoral | $45 | $29 |
| Preventive | |||
| 111 | Plaque/Stain Removal | $92 | $52 |
| 114 | Calculus Removal | $122 | $86 |
| 118 | Bleaching, External - Per Tooth | $117 | $50 |
| 121/111 | Topical Remineralising & Plaque | $111 | $43 |
| 141 | Oral Hygiene Instruction | $56 | $33 |
| 151 | Provision of Mouthguard | $259 | 15% Off Practice Fee |
| 161 | Fissure Sealing - Per Tooth | $66 | $46 |
| Periodontics | |||
| 222 | Root Planing & Curettage - Per Tooth | $199 | 15% Off Practice Fee |
| 232 | Perio Flap Surgery - Per Tooth | $406 | 15% Off Practice Fee |
| Oral Surgery | |||
| 311 | Removal of a Tooth or Part(s) Thereof | $193 | $126 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | NA | 15% Off Practice Fee |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | $406 | $275 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | NA | 15% Off Practice Fee |
| Endodontics | |||
| 411 | Direct Pulp Capping | $42 | $32 |
| 415 | Chemo-Mechanical Preparation - 1 Canal | $248 | $195 |
| 416 | Chemo-Mechanical Preparation - Additional Canal | $130 | $90 |
| 417 | Pulp Obturation - One Canal | $247 | $190 |
| 418 | Pulp Obturation - Each Additional Canal | $130 | $86 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | $250 | $137 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System - Per Tooth | $188 | $89 |
| Restorations | |||
| 511 | Metallic - 1 Surface | $172 | $110 |
| 512 | Metallic - 2 Surfaces | $212 | $127 |
| 513 | Metallic - 3 Surfaces | $247 | $166 |
| 514 | Metallic - 4 Surfaces | $310 | $184 |
| 515 | Metallic - 5 Surfaces | $359 | $199 |
| 521 | White Filling Adhesive - 1 Surface - Front Tooth | $180 | $118 |
| 522 | White Filling Adhesive - 2 Surfaces - Front Tooth | $222 | $137 |
| 523 | White Filling Adhesive - 3 Surfaces - Front Tooth | $247 | $172 |
| 524 | White Filling Adhesive - 4 Surfaces - Front Tooth | $310 | $195 |
| 525 | White Filling Adhesive - 5 Surfaces - Front Tooth | $378 | $211 |
| 531 | White Filling Adhesive - 1 Surface - Back Tooth | $180 | $125 |
| 532 | White Filling Adhesive - 2 Surfaces - Back Tooth | $233 | $160 |
| 533 | White Filling Adhesive - 3 Surfaces - Back Tooth | $288 | $187 |
| 534 | White Filling Adhesive - 4 Surfaces - Back Tooth | $321 | $219 |
| 535 | White Filling Adhesive - 5 Surfaces - Back Tooth | $378 | $242 |
| 575 | Pin Retention - Per Pin | $41 | $26 |
| 577 | Cusp Capping - Per Cusp | $59 | $29 |
| 578 | Restoration Incisal Corner - Per Corner | $59 | $33 |
| 582 | Composite Veneer - Direct - Per Tooth | $386 | $249 |
| 583 | Porcelain Veneer - Indirect - Per Tooth | $1,320 | $852 |
| Crowns & Bridges (Lab Fees Included) | |||
| 615 | Full Crown - Veneered - Indirect | $1,765 | $1,187 |
| 618 | Full Crown - Metallic - Indirect | $1,765 | $1,178 |
| 627 | Preliminary Restoration for Crown - Direct | $290 | $173 |
| 643 | Bridge Pontic - Indirect - Per Pontic | $1,480 | $915 |
| 651 | Re-cementing Crown or Veneer | $203 | $97 |
| 661 | Implant Abutment - Per Abutment | $934 | 15% Off Practice Fee |
| 672 | Full Crown to Implant - Veneered | $2,233 | 15% Off Practice Fee |
| 688 | Insert One-Stage Implant - Per Implant | $2,538 | 15% Off Practice Fee |
| Prosthodontics | |||
| 711 | Upper Denture | $1,624 | $1,035 |
| 719 | Upper & Lower Denture | $3,045 | $2,139 |
| 721/733/731 | Partial Denture Acrylic Plate - 6t2fe s | $1,279 | $723 |
| 727/728 | Partial Denture Plate - Cast Metal Framework - 2 Teeth | $1,441 | $1,187 |
| 733 | Tooth/Teeth (Partial Denture) | $54 | $29 |
| 741 | Adjustment of a Denture | $86 | $47 |
| 743 | Relining - Complete Denture - Processed | $457 | $345 |
| 763 | Repair Base - Complete Denture | $259 | $124 |
| 768 | Partial Denture – Extracted Tooth Replacement - Per Tooth | $259 | $148 |
| 776 | Impression for Denture Repair | $73 | $45 |
| Orthodontics | |||
| 821 | Active Removable Appliance - 1 Arch | $964 | 15% Off Practice Fee |
| 831 | Full Arch Banding - Per Arch | NA | 15% Off Practice Fee |
| General | |||
| 911 | Palliative Care | $122 | $70 |
| 925 | Individually Made Tray - Medicament(s) | $259 | $110 |
| 965 | Occlusal Splint | $673 | $425 |